Influence of early neurological complications on clinical outcome following lung transplant

Abstract

BackgroundNeurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied.MethodsWe investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014.ResultsFifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients’ survival.ConclusionsThe real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors.

Imaging findings of neurologic complications in lung transplantation: Review of a 9-year cohort

“…Lung transplantation (LT) constitutes a potentially life-saving procedure for many patients, and every year, the number of lung recipients continues to increase. Since the neurological complications after LT are common, 2 , 3 , 5 , 6 our purpose was to analyse the neuroimaging findings of a cohort of adult patients who underwent lung transplantation. The influence of nervous system disorders on lung transplant recipients and their survival has been studied by some articles.…”

“… 5 Gamez et al did not find associations with mortality. 2 They observed that neurological complications affected the mean length of hospital stay and especially the time spent in the intensive care unit. Smith et al reported that the 36%–44% of the patients exhibited postoperative delirium, which was associated with worse short-term clinical outcomes.…”

“…In our study, the frequency of clinical neurological events was 36.3%, lower than those reported in the available studies. 2 , 3 , 5 , 16 , 17 One reason for this difference is probably related to the surveillance period in a retrospective study. The data collection was made between 2018 and 2020 so patients who underwent LT in the last years were not followed for a long time (available LT series had a surveillance period of 10 years).…”

“…Our findings are similar to those reported in other adult series. 2 , 3 , 5 For instance, Mateen et al found that the most common neurological complications in the CNS were encephalopathy, strokes and seizures. 5 Smith et al published the most common early neurological sequelae were postoperative delirium and posterior reversible encephalopathy syndrome, followed by stroke/transient ischaemic attack and neurotoxicity.…”

“…4 Neurological complications after LT are common, affecting between 45% and 92% of patients in some studies. 2 , 3 , 5 The influence of nervous system disorders on lung transplant recipients and their survival has been studied. However, reviews of large cohorts, focused on neuroimaging findings in lung transplant recipients, have not been previously published.…”